Physical Medicine and Rehabilitation Physician

Position Overview
We are seeking an experienced Internal Medicine Physician to serve as a clinical reviewer for the ECR process. This role is essential to reviewing and certifying cases involving members ages 0–18. The physician will evaluate clinical assessments, review supporting medical records, consider information provided by the member or healthcare decision-maker, and develop clear, evidence-based clinical recommendations.
Key Responsibilities

• Serve as a primary clinical reviewer and certify assigned cases in accordance with the ECR process.
• Review clinical assessments, available medical records, and supporting documentation.
• Consider relevant information submitted by the member or their healthcare decision-maker.
• Evaluate complex medical conditions, comorbidities, treatment needs, and relevant clinical history.
• Assess the medical complexity and overall healthcare needs of children and adolescents ages 0–18.
• Seek discipline-specific consultation when necessary to support a comprehensive review.
• Synthesize information from multiple sources to develop clear, objective, and clinically supported recommendations.
• Document clinical findings, recommendations, and supporting rationales using the Division’s ECR process and designated templates.
• Complete assigned case reviews within the required 48-hour turnaround time from case assignment
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• Maintain accurate, thorough, and timely documentation in accordance with established review protocols.

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
• Appropriate, current medical licensure and credentials for the applicable jurisdiction.
• Specialty training or clinical experience in Internal Medicine.
• Strong knowledge of medical assessment, complex medical conditions, and clinical decision-making.
• Ability to interpret medical records, review clinical assessments, and synthesize information from multiple sources.
• Excellent written communication, analytical, and clinical documentation skills.
• Ability to meet strict deadlines and complete assigned reviews within required time frames.